Metabolic syndrome

Description:

Metabolic syndrome (MS, syndrome of X, insulin resistance syndrome) — the set of metabolic disturbances including excess body weight with formation of obesity on abdominal type, in-sulinorezistentnost, dislipidemiya and/or arterial hypertension. Also other symptoms of MS are observed: microalbuminuria, disturbances of system of a hemostasis.
MS frequency depending on criteria of inclusion is a little various. However dependence on age is accurately established. In the USA the MS was diagnosed for 6,7% inspected at the age of 20-29 years at 43,6% — 60-69 years and at 42% — of 70 years and is more senior. According to a WHO research in population of Novosibirsk at the age of 25-64 years the frequency of MS made 40%.

Reasons of the Metabolic syndrome:

The etiology is unknown. There are researches which indicate a role of the following factors of development of MS:
■ increases in a tone of a sympathetic nervous system;
■ insulin resistance;
■ giperandrogeniya;
■ deficit of an insulinopodobny growth factor;
■ roles of pro-inflammatory cytokines (FNO-a, S-reactive protein, IL-6, IL-10).
The metabolic syndrome — a diabetes mellitus prestage 2 types, differs from the last a stable hyperglycemia as insulin resistance at this stage is suppressed at the expense of a giperinsulinemiya. Decrease in body weight by increase in a physical activity and the adequate mode reduces risk of development of a diabetes mellitus 2 types by 30-50% already at this stage.
Influence of sex hormones on lipidic fabric:
Estrogen:
- increase in activity of lipoproteinlipase in a femoral rump;
- accumulation of lipids for providing stocks of energy during pregnancy and a lactation.
Progesterone:
- receptors to progesterone are found in an abdominal hypodermic fatty tissue;
- participates in regulation of exchange of fatty tissue;
- is a competitor of glucocorticoids for their receptors in lipoblasts in a late lyuteinovy phase, increases power consumption;
- in a postmenopause lack of progesterone explains metabolism delay.
Regulation by estrogen of products of a leptin adipocytes happens on a positive feedback mechanism. Leptin — the proteinaceous hormone synthesized by lipoblasts signals in a brain about a saturation threshold, about sufficiency of energy in an organism.
The nature of distribution of fatty tissue opredeleyatsya by sex hormones: estrogen and progesterone are responsible for localization of fat in buttock and femoral area (ginoidny), androgens — in abdominal (androidny).
Fatty tissue is a place of ekstragonadny synthesis and metabolism of estrogen in the course of what take part P450 aromatase.
Abdominal and especially visceral obesity — risk factor of cardiovascular diseases that is caused by specific anato-morfiziologichesky properties of such fatty tissue. Its blood supply improves, metabolic processes amplify, and lipoblasts have the high density of r-adrenoceptors (their stimulation leads to a lipolysis) at rather low density and - adrenoceptors and insulin receptors which it stimulyatsya blocks a lipolysis.  
The intensive lipolysis in fatty tissue of abdominal and visceral area leads to increase in level of free fatty acids in a system blood-groove because of what there is a metabolism disturbance, characteristic of abdominal obesity: insulin resistance, increase in level of glucose, insulin, LPONP and triglycerides in blood.
At insulin resistance oxidation of lipids is not suppressed and, respectively, there is an allocation of a large amount of free fatty acids from lipoblasts. Besides, excess of free fatty acids activates a gluconeogenesis, accelerates synthesis and breaks elimination of HS-LPONP and triglycerides that is followed by decrease in the HS-LPVP levels. Dislipoproteidemiya, in turn, aggravates a condition of insulin resistance what reduction of number of receptors to insulin in target tissues at increase in maintenance of HS-LPNP testifies to, for example.
The interrelation between arterial hypertension and a giperinsulinemiya is explained:
■ strengthening of a reabsorption of sodium in kidneys (antidiuretic effect);
■ stimulation of a sympathetic nervous system and products of catechol - min;
■ the strengthened proliferation of smooth muscle cells of vessels and izmenekniy concentration of ions of sodium in an endothelium of vessels.
At menopausal MS against the background of deficit of sex hormones concentration of the protein connecting sexual steroids that leads to growth of the contents of free androgens in blood which can in itself reduce the LPVP level is lowered and cause insulin resistance and a giperinsulinemiya.
At obesity and insulin resistance there is an activation of factors of pro-inflammatory reaction [FNOA, SILT-6, inhibitor of a plasminogen activator-1 (IAP-1), free fatty acids, angiotensinogen II] that leads to endothelial dysfunction, an oxidative stress, the inflammatory cascade of cytokines, promoting atherosclerotic changes and development of insulin resistance.
The interrelation between system of a hemostasis and insulin resistance is explained with direct dependence between the level of insulin and activity of factors of VII, by X and (IAP-1): insulin stimulates their secretion.
All components of a metabolic syndrome: insulin resistance, a dislipoproteidemiya, a hyperactivity of a sympathetic nervous system — are interconnected, but each of them is surely connected with abdominal obesity which is considered a key sign of a metabolic syndrome.

Symptoms of the Metabolic syndrome:

Allocation of MS is clinically significant because this state, on the one hand, is exposed to involution, and with another - 2 types, but also essential AG and atherosclerosis are a basis of a pathogeny not only a diabetes mellitus.
Besides, by number of the major factors of risk of development of an ischemic heart disease entering MS (upper type of obesity, disturbance of tolerance to glucose, a lipidemia, AG) it is determined as "the deadly quartet". The MS includes the following main components:
■ insulin resistance;
■ a giperinsulinemiya and the increased S-peptide level;
■ disorder of tolerance to glucose;
■ gipertriglitseridemiya;
■ decrease in the LPVP level and/or increase in the LPNP level;
■ abdominal (androidny, visceral) obesity type;
■ AG;
■ to a giperandrogeniye at women;
■      the increased content of glycated hemoglobin and fructosamine, emergence of protein in urine, disturbance of exchange of purines, a polycythemia, a hypernatremia.
The MS can demonstrate in the form of any of the listed states, all components of a syndrome observe not always.
Abdominal obesity — the main clinical symptom of a metabolic syndrome.
The menstrual cycle on type of an oligomenorrhea, metrorrhagias, anovulations is quite often broken. Quite often polycystic ovaries come to light.
Obesity increases risk:
- cardiovascular diseases;
- an obstructive apnoea in a dream (snore);
- diabetes mellitus;
- osteoarthritis;
- arterial hypertension;
- liver pathologies;
- rectum cancer;
- psychological problems;
- breast cancer.
The apnoea obstructive in a dream is observed at 60 — 70% of people with obesity. Cardiac arrhythmia, myocardium ischemia, a hyperventilation syndrome, pulmonary hypertensia, cardiovascular insufficiency, a stroke are characteristic drowsiness in the afternoon.

Treatment of the Metabolic syndrome:

Treatment purpose: safe decrease in body weight, recovery of reproductive functions at their disturbance.

Effective to a lecheniyaa of a metabolic syndrome includes:
and. formation and maintenance of internal motivation of the patient to decrease in body weight;
. continuous contact with the patient with statement and approval of the intermediate purposes of treatment and control of their achievement.
Non-drug treatment:
- Lectures for patients.
- Rational hypo - and eukaloriyny food.
- Increase in physical activity.
- Normalization of a way of life.
- The operational treatment directed to reduction of volume of a stomach.
Medicamentous therapy:
- Selective serotonin reuptake inhibitor and noradrenaline (сибутрамин) on 10-15 mg a day: causes bystry emergence and prolongation of feeling of saturation and, as a result, reduction of volume of the consumed food. An initial dose of a sibutramin of 10 mg a day. At loss of body weight less than 2 kg during 4 weeks the dose is increased to 15 mg a day. Drug is contraindicated at arterial hypertension.
- Drug of peripheral influence — орлистат inhibits enzymatic systems of intestines, reducing amount of free fatty acids and monoglycerides in a small intestine. The most effective dosage — 120 mg 3 times a day. Along with weight reduction against the background of treatment Xenical noted normalization or a reliable lowering of arterial pressure, the level of the general cholesterol, HS-LPNP, triglycerides that demonstrates reduction of risk of development of cardiovascular diseases. Xenical has good tolerance and is safe.
- Antidepressants — selective serotonin reuptake inhibitors are shown to patients with alarming and depressive frustration, the panic attacks and neurotic bulimia: fluoxetine — a daily dose from 20 to 60 mg within 3 months or флувоксамин on 50 — 100 mg a day within 3 months.
Pathogenetic medicamentous therapy of menopausal MS — replaceable hormonal therapy.

Decrease in body weight finally promotes decrease in risk of development of cardiovascular diseases, cancer, prevention of a diabetes mellitus 2 types, to decrease in frequency of an apnoea and an osteoarthritis. Mechanisms of achievement of a net result after decrease in body weight quite difficult also include:
- lipid metabolism normalization;
- decrease in the ABP, concentration of insulin, pro-inflammatory cytokines, risk of a thrombogenesis, oxidative stress.
As at the women of reproductive age suffering from MS quite often observe an oligomenorrhea, as a rule, decrease in body weight by 10% and more contributes to normalization of menstrual cycles at 70% of women and to recovery of an ovulation — at 37% of women without hormonal drugs. ZGT at a MMS are promoted decrease in body weight, reduction of an index by a circle a waist/circle of hips, normalization of level of insulin and a lipidic range of blood.

The remaining surplus of body weight increases risk of cardiovascular diseases, defeats of a musculoskeletal system, and also some obstetric and gynecologic diseases (a hyperplasia of an endometria, DMK, weakness of sokratitelny activity of a uterus in labor).